{"version":"0.4","data":[{"t":"Demographics","q":[{"name":"DARLENE D DRAKE","gend":1,"currentgend":"","add":"3245 S Fern St","city":"Wichita","state":"KS","zip":"67217","age":"","mstatus":"","insh":"K44007295","cliId":"","pno":"3163644463","cno":"","email":"","ename":"","eno":"","pphy":"ANDREA MCCARTY","ppno":"3167219500","pcpadd":"8444 W 21ST ST N","pcpcity":"WICHITA","pcpstate":"KS","pcpzip":"67205-1752","pcpcounty":"","pcpid":"","pcpname":"ASCENSION MEDICAL GROUP VIA CHRISTI PA","plan":"BCBSKS","program":"Medicare","lob":"012","region":"","aligned":"","ano":"","add2":"","add3":"","madd1":"3245 S Fern St","madd2":"","madd3":"","mcity":"Wichita","mstate":"KS","mzip":"67217","pcpfaxno":"","pcpnpi":"1063470938","currentgendcomment":"","pphycomment":"","uniqueid":"M3AK44007295","medicareid":"7JA8K48TM47","medicaidid":"7JA8K48TM47","pcpFlag":"","dob":"1954-12-06"},{"a":{"indx":["","","","","","","","1"],"comment":["","","","","","","",""],"sub":{"indx":[["No Ethnicity"]],"comment":[[""]],"sub":[]}}},{"a":[]},{"a":{"indx":["1",""],"comment":["",""],"sub":[]}},{"a":[]},{"a":[]}]},{"t":"Previously Documented Conditions","q":{"0":{"a":{"diag":["E785","I10","R7303","L4050","E559","M3500","Z79899","E782","M3390","J309","L4059","L408","M25511","M25611","M1990","R002","R5383","R0683","E6601","I340","Z981","M5416","R531"],"date":["2026-01-02","2026-01-02","2026-01-12","2025-07-01","2026-01-05","2026-01-29","2026-05-29","2026-01-12","2026-05-29","2025-11-10","2025-12-12","2025-12-12","2025-02-04","2025-02-04","2025-01-14","2026-01-02","2026-01-02","2025-04-14","2025-04-14","2025-04-14","2026-03-10","2026-06-10","2026-05-29"],"priorHcc":["","","","","","","","","","","","","","","","","","","","","","",""]}},"1":{"a":[]},"3":{"a":{"indx":["1",""],"comment":["",""],"sub":[]}}}},{"t":"COVID Screening","q":[{"a":[]},{"a":[]},{"a":[]}]},{"t":"Self-Assessment and Social History (SDOH)","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Activities of Daily Living","q":[{"a":[]}]},{"t":"Medical History","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Family History","q":[{"a":[]}]},{"t":"Preventive Care","q":[{"a":[]},{"a":[]},{"a":[]}]},{"t":"Allergies \/ Medications","q":[{"a":[]},{"a":{"comment":"","sub":[["","","TRIAMCINOLONE ACETONIDE","0.10%","","Select","Select",""],["","","LOSARTAN POTASSIUM","50 MG","","Select","Select",""],["","","BACLOFEN","5 MG","","Select","Select",""],["","","MYCOPHENOLATE MOFETIL","500 MG","","Select","Select",""],["","","DILTIAZEM HYDROCHLORIDE ER","180 MG","","Select","Select",""],["","","TRAZODONE HYDROCHLORIDE","100 MG","","Select","Select",""],["","","OMEPRAZOLE","40 MG","","Select","Select",""],["","","CITALOPRAM HYDROBROMIDE","40 MG","","Select","Select",""],["","","SHINGRIX","50\/0.5 ML","","Select","Select",""],["","","HYDROCODONE BITARTRATE\/ACETAMINOPHEN","325 MG","","Select","Select",""],["","","FLUAD 2025-2026","","","Select","Select",""],["","","ALBUTEROL SULFATE HFA","","","Select","Select",""],["","","RESTASIS","0.05%","","Select","Select",""],["","","DOXYCYCLINE HYCLATE","100 MG","","Select","Select",""],["","","BOOSTRIX","","","Select","Select",""],["","","AREXVY","120 MCG","","Select","Select",""],["","","PREDNISONE","20 MG","","Select","Select",""],["","","AMOXICILLIN","500 MG","","Select","Select",""],["","","HUMIRA PEN","40\/0.4 ML","","Select","Select",""],["","","Arexvy Inj","120 MCG","","Select","Select",""],["","","Losartan Pot Tab","50 MG","","Select","Select",""],["","","Triamcinolon Cre 0.1%","","","Select","Select",""],["","","Fluad Inj 2025-26","","","Select","Select",""],["","","Doxycycl Hyc Cap","100 MG","","Select","Select",""],["","","Citalopram Tab","40 MG","","Select","Select",""],["","","Mycophenolat Tab","500 MG","","Select","Select",""],["","","Trazodone Tab","100 MG","","Select","Select",""],["","","Amoxicillin Cap","500 MG","","Select","Select",""],["","","Humira Pen Inj","40\/0.4 ML","","Select","Select",""],["","","Shingrix Inj","50\/0.5 ML","","Select","Select",""],["","","Hydroco\/Apap Tab 5-325Mg","","","Select","Select",""],["","","Prednisone Tab","20 MG","","Select","Select",""],["","","Restasis Emu 0.05% Op","","","Select","Select",""],["","","Baclofen Tab","5 MG","","Select","Select",""],["","","Boostrix Inj","","","Select","Select",""],["","","Diltiazem Cap","180 MG","","Select","Select",""],["","","Albuterol Aer Hfa","","","Select","Select",""],["","","Omeprazole Cap","40 MG","","Select","Select",""]]}},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Assessment of Diagnoses","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Pain","q":[{"a":[]}]},{"t":"Vital Signs","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Exam Review","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Screenings Needed","q":[{"a":{"indx":["",""],"comment":["",""],"sub":[]}},{"a":{"indx":["",""],"comment":["",""],"sub":[]}},{"a":{"indx":["",""],"comment":["",""],"sub":[]}},{"a":{"indx":["",""],"comment":["",""],"sub":[]}},{"a":{"indx":["",""],"comment":["",""],"sub":[]}},{"a":{"indx":["",""],"comment":["",""],"sub":[]}},{"a":{"indx":["",""],"comment":["",""],"sub":[]}},{"a":{"indx":["","1"],"comment":["",""],"sub":[]}},{"a":[]}]},{"t":"Mini-Cog","q":[{"a":[]},{"a":[]},{"a":[]}]},{"t":"Home Safety & Personal Goals","q":[{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]},{"a":[]}]},{"t":"Active Problem Conditions","q":[{"a":[]}]},{"t":"Patient Summary","q":[{"a1":"","a2":"","a3":"","a4":"","a5":"","a6":"","a7":[],"a8":"","a9":"","a10":[],"a11":"","a12":"","a13":""}]}]}